BONE-MINERAL DENSITY, SERUM INSULIN-LIKE-GROWTH-FACTOR-I, AND BONE TURNOVER MARKERS IN VIRAL CIRRHOSIS

Previous studies suggest that low bone mass is a complication of alcoh olic liver disease. Nevertheless, little is known about bone mass and bone metabolism in viral cirrhosis. To evaluate the prevalence and mag nitude of hepatic osteopenia in these patients, bone remodeling status , and its relationship with the severity of liver disease and serum le vels of insulin-like growth factor I (IGF-I), we studied 32 consecutiv e patients with viral cirrhosis and no history of alcohol intake. Bone mineral density (BMD) was measured by dual x-ray absorptiometry in th e lumbar spine (LS) and femoral neck (FN), and the values were express ed as the z score. Bone metabolism markers and hormone profiles were m easured. Patients with viral cirrhosis showed reduced BMD in all sites (LS: -1.27 +/- 1.06, P < .001; FN: -0.48 +/- 0.96; P < .01). Of the 3 2 patients, 53% met the diagnostic criteria for osteoporosis. In patie nts, urine deoxypyridinoline (D-Pyr) as a marker of bone resorption an d serum bone alkaline phosphatase (b-AP) as a marker of bone formation were significantly higher than in control subjects (P < .001 and P < .01, respectively). Serum IGF-I was lower than in control subjects (P < .001), and significant differences were also found between patients with and without osteoporosis (P < .05), BMD in LS correlated with sev erity of the disease, with serum levels of IGF-I, and with urine D-Pyr , Our findings show that viral cirrhosis is a major cause of osteoporo sis in men, and that low serum IGF-I levels seem to play a role in the bone mass loss in these patients. The biochemical markers of bone rem odeling suggest high-turnover osteoporosis in patients with viral cirr hosis.